Functional constipation and pelvic floor dysfunction

Constipation is variably defi ned, and its diagnosis is often arbitrary. Patients with functional constipation (FC) present with diffi cult, infrequent, or seemingly incomplete defecation without meeting criteria for irritable bowel syndrome. There are a variety of secondary causes of constipation, including medications that slow colonic transit. A functional defecation disorder secondary to pelvic fl oor dysfunction (PFD) is a common, often under - appreciated abnormality in patients presenting with constipation. While fi ber supplementation and osmotic laxatives are successful for many patients with FC, the treatment of choice for PFD is pelvic fl oor rehabilitation (biofeedback). Therefore, a stepwise diagnostic and therapeutic approach to patients with FC based on historical and physical examination features is recommended. Clinical awareness and focused testing to identify the physiologic abnormalities underlying constipation facilitate management and improve patient outcomes.